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Sahn B, Eze OP, Edelman MC, Chougar CE, Thomas RM, Schleien CL, Weinstein T. Features of Intestinal Disease Associated With COVID-Related Multisystem Inflammatory Syndrome in Children. J Pediatr Gastroenterol Nutr 2021; 72:384-387. [PMID: 32969960 PMCID: PMC7901530 DOI: 10.1097/mpg.0000000000002953] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022]
Abstract
ABSTRACT Multisystem inflammatory syndrome in children (MIS-C) is a recently identified syndrome that appears to be temporally associated with novel coronavirus 2019 infection. MIS-C presents with fever and evidence of systemic inflammation, which can manifest as cardiovascular, pulmonary, neurologic, and gastrointestinal (GI) system dysfunction. Presenting GI symptoms are seen in the majority, including abdominal pain, diarrhea, and vomiting. Any segment of the GI tract may be affected; however, inflammation in the ileum and colon predominates. Progressive bowel wall thickening can lead to luminal narrowing and obstruction. Most will have resolution of intestinal inflammation with medical therapies; however, in rare instances, surgical resection may be required.
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Affiliation(s)
- Benjamin Sahn
- Division of Gastroenterology, Liver Disease, and Nutrition, Department of Pediatrics
| | | | - Morris C. Edelman
- Division of Pediatric Pathology, Zucker School of Medicine at Hofstra/Northwell, Steven & Alexandra Cohen Children's Medical Center, Northwell Health
| | | | | | | | - Toba Weinstein
- Division of Gastroenterology, Liver Disease, and Nutrition, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Steven & Alexandra Cohen Children's Medical Center, Northwell Health
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Rico Espiñeira C, Souto Romero H, Espinosa Góngora R, Espinoza Vega ML, Alonso Calderón JL. Acute abdomen in COVID-19 disease: the pediatric surgeon's standpoint. Cir Pediatr 2021; 34:3-8. [PMID: 33507637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.
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Affiliation(s)
- C Rico Espiñeira
- Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)
| | - H Souto Romero
- Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)
| | - R Espinosa Góngora
- Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)
| | - M L Espinoza Vega
- Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)
| | - J L Alonso Calderón
- Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)
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Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal Symptoms as a Major Presentation Component of a Novel Multisystem Inflammatory Syndrome in Children That Is Related to Coronavirus Disease 2019: A Single Center Experience of 44 Cases. Gastroenterology 2020; 159:1571-1574.e2. [PMID: 32505742 PMCID: PMC7270806 DOI: 10.1053/j.gastro.2020.05.079] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan Miller
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Amanda Cantor
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Philip Zachariah
- Department of Pediatrics, Division of Pediatric Infectious Disease, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Danielle Ahn
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Mercedes Martinez
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Kara Gross Margolis
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York.
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Suresh Kumar VC, Mukherjee S, Harne PS, Subedi A, Ganapathy MK, Patthipati VS, Sapkota B. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterol 2020; 7:e000417. [PMID: 32457035 PMCID: PMC7252994 DOI: 10.1136/bmjgast-2020-000417] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19. METHODS A literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3. RESULTS Pooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%). CONCLUSION Our study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.
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Affiliation(s)
| | - Samiran Mukherjee
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Prateek Suresh Harne
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abinash Subedi
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Muthu Kuzhali Ganapathy
- Department of General Medicine, Sri Ramaswamy Memorial Group of Educational Institutions, Chennai, Tamil Nadu, India
| | | | - Bishnu Sapkota
- Division of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York, USA
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
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Geboers B, Verveld CJ, Bronner I, van de Ven AHW. [Abdominal wall paresis as a complication of herpes zoster]. Ned Tijdschr Geneeskd 2018; 162:D1949. [PMID: 29303097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Herpes zoster is an illness which is especially common amongst the elderly in the Netherlands and which can express itself in various ways. Besides affecting sensory nerves, which leads to postherpetic pain, the varicella zoster virus may also invade motor nerves. CASE DESCRIPTION A 73-year-old female went to the surgeon with symptoms of a painful swelling in the left lower abdomen. She had experienced herpes zoster at the site of the swelling a few months earlier. A CT scan revealed asymmetry of the abdominal wall musculature, which led us to suspect a link between motor involvement of herpes zoster and the abdominal swelling. EMG revealed denervation of the affected abdominal wall muscle, which confirmed the link with herpes zoster in that dermatome. CONCLUSION Abdominal wall paresis caused by herpes zoster is a rare condition. It can be diagnosed on the basis of clinical findings and may be confirmed by EMG investigation of the affected muscle. In view of the temporary nature of the paresis, it is possible to opt for conservative management of the condition.
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Börcek P, Özdemir BH, Özgün G, Haberal M. Posttransplant Lymphoproliferative Disorder Manifesting as Intestinal Epstein-Barr Virus-Positive Anaplastic Large-Cell Lymphoma in an Adult Renal Transplant Recipient. EXP CLIN TRANSPLANT 2016; 14:64-66. [PMID: 27805515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Posttransplant lymphoproliferative disorder is a relatively common posttransplant malignancy affecting as many as 10% of all solid-organ recipients. Most cases of posttransplant lymphoproliferative disorder are of B-cell origin, with common Epstein-Barr virus association. Posttransplant lymphoproliferative disorders of T-cell origin are much rarer and less frequently associated with Epstein-Barr virus. Here, we report an unusual case of Epstein-Barr virus-positive anaplastic large-cell lymphoma causing an intestinal perforation in an adult renal transplant recipient. A 52-year-old male patient with renal allograft developed cryptogenic end-stage liver failure and was accepted as a candidate for liver transplant. Before transplant, he was admitted with severe abdominal pain, which turned out to result from ileal perforation. Pathologic evaluation of the intestinal resection showed diffuse malignant lymphoid infiltration of the ileum, consistent with anaplastic large-cell lymphoma. The tumor was positive for Epstein-Barr virus genome. Anaplastic large-cell lymphoma is a rare form of T-cell posttransplant lymphoproliferative disorder that is infrequently associated with Epstein-Barr virus. The occurrence of this extraordinary form of post transplant lymphoproliferative disorder, its late onset, intestinal localization, and Epstein-Barr virus as sociation represent a unique clinical rarity.
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Affiliation(s)
- Pelin Börcek
- From the Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
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Gupta BP, Adhikari A, Rauniyar R, Kurmi R, Upadhya BP, Jha BK, Pandey B, Manandhar KD. Dengue virus infection in a French traveller to the hilly region of Nepal in 2015: a case report. J Med Case Rep 2016; 10:65. [PMID: 26997343 PMCID: PMC4800766 DOI: 10.1186/s13256-016-0847-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue viral infections are known to pose a significant risk during travel to tropical regions, but it is surprising to find dengue transmission in the hilly region of Nepal, which is over 1800mtr above sea level. CASE PRESENTATION A 43-year-old Caucasian female traveler from France presented with fever and abdominal pain following a diarrheal illness while visiting the central hilly region of Nepal. Over the course of 9 days, she developed fever, body aches, and joint pain, with hemorrhagic manifestation. She was hospitalized in India and treated with supportive care, with daily monitoring of her platelets. An assessment by enzyme-linked immunosorbent assay showed that she was positive for dengue non-structural protein 1. Upon her return to France, dengue virus was confirmed by reverse transcriptase-polymerase chain reaction. CONCLUSION The district where this dengue case was reported is in the hilly region of Nepal, neighboring the capital city Kathmandu. To the best of our knowledge, there has previously been no dengue cases reported from the district. This study is important because it aims to establish a potential region of dengue virus circulation not only in the tropics, but also in the subtropics as well, which in Nepal may exceed elevations of 1800mtr. This recent case report has raised alarm among concerned health personnel, researchers, and organizations that this infectious disease is now on the way to becoming established in a temperate climate.
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Affiliation(s)
- Birendra Prasad Gupta
- />Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kritipur, Kathmandu, Nepal
| | - Anurag Adhikari
- />Asian Institute of Technology and Management, Purbanchal University, Lalitpur, Nepal
| | | | - Roshan Kurmi
- />Bhawani Hospital and Research Center, Birgunj, Nepal
| | | | | | - Basudev Pandey
- />Leprosy Division, Ministry of Health, Government of Nepal, Kathmandu, Nepal
| | - Krishna Das Manandhar
- />Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kritipur, Kathmandu, Nepal
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Çöl D, Biçer S, Uğraş M, Küçük Ö, Giray T, Gürol Y, Erdağ GÇ, Vitrinel A, Çelik G, Kaspar Ç. Relative frequency of norovirus infection in children with acute gastroenteritis. Minerva Pediatr 2015; 67:19-24. [PMID: 25602748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study was to determine the prevalence of norovirus among children with acute gastroenteritis in 2009 and 2010. We also aimed that, to detecting the possible clinical and laboratory differences among cases in 2009 and 2010. METHODS Fecal samples were collected from children under 16 years of age who were admitted for acute gastroenteritis. Norovirus was detected using immunochromatography. For the comparison of seasonal distribution, clinical manifestations, and laboratory results between cases, we divided subjects into two groups by year. RESULTS Norovirus infection was detected in 112 of the 1027 collected samples (10.9%). In three cases with norovirus, other enteric viruses like rotavirus and adenovirus are detected concurrently, and these were excluded. After the exclusion of three cases with co-infections, statistical analysis was made in 109 cases. Most of the positive cases were between 1-24 months of age (N.=75, 67%). The rate of norovirus infection peaked in winter in 2010 (P<0.05). However, the rates were not significantly different between seasons in 2009 (P>0.05). We did not detect any positive cases in late summer and autumn in 2010. Diarrhea (97.2%), vomiting (95.4%), and abdominal pain (65.1%) were most frequently encountered symptoms of patients with norovirus. Leukocytosis and neutrophilia were significantly higher in 2010 than 2009 (P<0.05). CONCLUSION The prevalence and clinical characteristics of norovirus in our study group is similar but seasonal distribution is different between two years. Most of the cases were <24 months of age. Like rotavirus, norovirus vaccine can be developed to prevent infection.
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Affiliation(s)
- D Çöl
- Department of Child Health and Diseases, Faculty of Medicine, Yeditepe University, Ataşehir, İstanbul, Turkey -
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Abstract
In mid-September 2009, a 22-year-old critically ill Soldier was medically evacuated from a treatment facility in southern Afghanistan to Landstuhl Regional Medical Center in Germany. Despite the efforts of the team at Landstuhl, this patient died and became the US military's first known victim of Crimean-Congo hemorrhagic fever (CCHF). CCHF is caused by a virus, which bears the same name. Because a vaccine is lacking, as well as an effective antiviral treatment, prevention is key.
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Abstract
Liver dysfunction was identified in a 16-year-old boy hospitalized with high fever and abdominal pain and fullness. He had received pharmacotherapy for a headache 2 months previously and other drugs for a high fever 4 days prior to being admitted to our hospital. The patient's liver dysfunction was consistent with and fulfilled the criteria for drug induced liver injury, but the laboratory findings showed elevated procalcitonin levels, hyponatremia and leukocytosis. Moreover, we confirmed the presence of human herpesvirus 6 (HHV-6) DNA. The patient exhibited symptoms of high fever and abdominal pain and fullness but no exanthema. The clinical and laboratory findings did not satisfy the criteria for drug-induced hypersensitivity syndrome, and we speculate that the diversity of clinical and laboratory findings may have resulted from HHV-6 reactivation. To the best of our knowledge, this is the first case report on drug-induced liver injury with various findings due to HHV-6 reactivation. HHV-6 reactivation should be considered in patients with drug induced liver injury even in the absence of exanthema.
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Affiliation(s)
- Masashi Fujita
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
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Wang Z, Ye J, Han YH. Acute pancreatitis associated with herpes zoster: Case report and literature review. World J Gastroenterol 2014; 20:18053-18056. [PMID: 25548507 PMCID: PMC4273159 DOI: 10.3748/wjg.v20.i47.18053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/02/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
Varicella-zoster virus (VZV) is a type of herpes virus known to cause varicella, mainly in young children, and herpes zoster in adults. Although generally non-lethal, VZV infection can be associated with serious complications, particularly in adults. Acute pancreatitis caused by VZV infection is a rare event, with reports primarily concerning immunocompromised individuals. Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection. The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side. A diagnosis of acute pancreatitis was confirmed based on abdominal pain, elevated levels of urine and serum amylase, and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography. This case highlights that, though rare, acute pancreatitis should be considered in VZV patients who complain of abdominal pain, especially in the epigastric area. Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality.
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Bhattarai P, Pierr L, Adeyinka A, Sadanandan S. Splenic Infarct: A Rare Presentation in a Pediatric Patient. JNMA J Nepal Med Assoc 2014; 52:1017-1019. [PMID: 26982903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
A previously healthy 16-year-old male presented with a two day history of persistent epigastric pain. His physical examination was significant for tenderness in the left hypochondriac region with a palpable spleen 2cm below the left sub-costal margin. A CT scan of the abdomen showed a splenic infarct. Heterophile and EBV VCA IgM antibody test were positive. This is a rare case of infectious mononucleosis presenting with splenic infarct in an adolescent male without co-morbidities.
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Affiliation(s)
- P Bhattarai
- The Brooklyn Hospital Center, Brooklyn NY, The United States of America
| | - L Pierr
- The Brooklyn Hospital Center, Brooklyn NY, The United States of America
| | - A Adeyinka
- The Brooklyn Hospital Center, Brooklyn NY, The United States of America
| | - S Sadanandan
- The Brooklyn Hospital Center, Brooklyn NY, The United States of America
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Khanna S, Vij JC, Kumar A, Singal D, Tandon R. Dengue fever is a differential diagnosis in patients with fever and abdominal pain in an endemic area. Annals of Tropical Medicine & Parasitology 2013; 98:757-60. [PMID: 15509430 DOI: 10.1179/000349804x3153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Khanna
- Pushpawati Singhania Research Institute for Liver, Renal and Digestive Disease, Press Enclave Marg, Sheikh Sarai, Phase-II, New Delhi - 110017, India.
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Hood J, Kanayama-Trivedi S, Hargett J. Dermatomal rash on a 6 year-old boy. J Fam Pract 2011; 60:485-487. [PMID: 21814644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jan Hood
- Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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Colson P, Richet H, Desnues C, Balique F, Moal V, Grob JJ, Berbis P, Lecoq H, Harlé JR, Berland Y, Raoult D. Pepper mild mottle virus, a plant virus associated with specific immune responses, Fever, abdominal pains, and pruritus in humans. PLoS One 2010; 5:e10041. [PMID: 20386604 PMCID: PMC2850318 DOI: 10.1371/journal.pone.0010041] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/09/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recently, metagenomic studies have identified viable Pepper mild mottle virus (PMMoV), a plant virus, in the stool of healthy subjects. However, its source and role as pathogen have not been determined. METHODS AND FINDINGS 21 commercialized food products containing peppers, 357 stool samples from 304 adults and 208 stool samples from 137 children were tested for PMMoV using real-time PCR, sequencing, and electron microscopy. Anti-PMMoV IgM antibody testing was concurrently performed. A case-control study tested the association of biological and clinical symptoms with the presence of PMMoV in the stool. Twelve (57%) food products were positive for PMMoV RNA sequencing. Stool samples from twenty-two (7.2%) adults and one child (0.7%) were positive for PMMoV by real-time PCR. Positive cases were significantly more likely to have been sampled in Dermatology Units (p<10(-6)), to be seropositive for anti-PMMoV IgM antibodies (p = 0.026) and to be patients who exhibited fever, abdominal pains, and pruritus (p = 0.045, 0.038 and 0.046, respectively). CONCLUSIONS Our study identified a local source of PMMoV and linked the presence of PMMoV RNA in stool with a specific immune response and clinical symptoms. Although clinical symptoms may be imputable to another cofactor, including spicy food, our data suggest the possibility of a direct or indirect pathogenic role of plant viruses in humans.
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Affiliation(s)
- Philippe Colson
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 6236 – Institut de Recherche pour le Développement (IRD) 3R198, Facultés de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - Hervé Richet
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 6236 – Institut de Recherche pour le Développement (IRD) 3R198, Facultés de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France
| | - Christelle Desnues
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 6236 – Institut de Recherche pour le Développement (IRD) 3R198, Facultés de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France
| | - Fanny Balique
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 6236 – Institut de Recherche pour le Développement (IRD) 3R198, Facultés de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France
- Institut National de la Recherche Agronomique (INRA), Unité de Recherche (UR) 407, Unité de Pathologie Végétale, Montfavet, France
| | - Valérie Moal
- Centre de Néphrologie et Transplantation Rénale, Centre Hospitalo-Universitaire Conception, Marseille, France
| | - Jean-Jacques Grob
- Service de Dermatologie, Centre Hospitalo-Universitaire Sainte-Marguerite, Marseille, France
| | - Philippe Berbis
- Service de Dermatologie, Centre Hospitalo-Universitaire Nord, Marseille, France
| | - Hervé Lecoq
- Institut National de la Recherche Agronomique (INRA), Unité de Recherche (UR) 407, Unité de Pathologie Végétale, Montfavet, France
| | - Jean-Robert Harlé
- Service de Médecine Interne, Centre Hospitalo-Universitaire Conception, Marseille, France
| | - Yvon Berland
- Centre de Néphrologie et Transplantation Rénale, Centre Hospitalo-Universitaire Conception, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 6236 – Institut de Recherche pour le Développement (IRD) 3R198, Facultés de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Marseille, France
- * E-mail:
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Brncić N, Mijandrusić-Sincić B, Perić R, Milić S, Gorup L, Mazur-Grbac M. Splenic hematoma as a first manifestation of cytomegalovirus infection. Coll Antropol 2010; 34 Suppl 2:267-269. [PMID: 21305741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Splenic rupture is rare but life threatening complication of mononucleosis syndrome. It has been suggested that subcapsular splenic hematoma formation precedes rupture. The case of 44-year-old, previously healthy, male with splenic hematoma occurring after rising of heavy cargo is reported. Mononucleosis syndrome was suggested based on routine laboratory tests (elevated white blood cell count with predominance of lymphocytes and raised serum transaminases) and CMV infection was confirmed by serological test. Nonoperative management was used since the patient was hemodynamically stable with no further signs of splenic rupture. The same approach has been used in growing number of cases of patients with spontaneous splenic rupture in mononucleosis syndrome. Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent patient.
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Affiliation(s)
- Nada Brncić
- Department of Infectious Diseases, University Hospital Center Rijeka, Rijeka, Croatia.
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18
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Nachman F, Ahumada J, Cabanne A, Cáneva J, Mauriño E. [A 65-year-old man with abdominal pain and hematochezia]. Acta Gastroenterol Latinoam 2009; 39:237-300. [PMID: 20178249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Fabio Nachman
- Unidad de Gastroenterología y Nutrición, Rehabilitación y Transplante Intestinal, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.
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19
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Freitas GPD. [Abdominal pain and thickening of the gallbladder wall]. Acta Gastroenterol Latinoam 2008; 38:172-231. [PMID: 18979893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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20
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Uehara PM, da Cunha RV, Pereira GROL, de Oliveira PA. Envolvimento hepático em pacientes com dengue hemorrágico: manifestação rara? Rev Soc Bras Med Trop 2006; 39:544-7. [PMID: 17308699 DOI: 10.1590/s0037-86822006000600006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Accepted: 12/04/2006] [Indexed: 01/09/2023] Open
Abstract
As manifestações hepáticas são descritas como não usuais no dengue e podem evoluir com quadros graves e potencialmente letais. Avaliamos as alterações hepáticas em 41 pacientes com dengue hemorrágico com confirmação laboratorial (ELISA IgM positivo) em Campo Grande, Mato Grosso do Sul, Brasil e observamos 61% (25/41) de alteração na alanina aminotransferase e 80,5% (33/41) na aspartato aminotransferase, sendo que não houve diferenças estatisticamente significativas quando comparamos as várias formas clínicas. A variação nos valores de ALT foi de 14-547U/l, nos valores da AST foi de 11-298U/l. Náuseas e/ou vômitos foram referidos por 90% (37/41) dos pacientes, 46,3% (19/41) referiram dor abdominal e 10% (3/29) apresentavam hepatomegalia ao exame físico. A idade variou de 18 a 88 anos, 23 (56%) eram mulheres e 18 (44%) homens.
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Affiliation(s)
- Patrícia Moreira Uehara
- Serviço de infectologia, Hospital Universitário, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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21
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Abstract
Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality among patients receiving chronic maintenance immunosuppression and is often considered the most important infection in renal transplantation. CMV gastritis has been reported in transplant patients. We present a case of CMV gastritis with epigastric pain that decreased in supine position, increased while sitting, and further increased when standing or walking. To our knowledge this is the second article presented to the literature so far.
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Affiliation(s)
- P Moustafellos
- Oxford Transplant Unit, Oxford Radcliffe NHS Trust, Oxford, UK.
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22
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Pishvaian AC, Bahrain M, Lewis JH. Fatal varicella-zoster hepatitis presenting with severe abdominal pain: a case report and review of the literature. Dig Dis Sci 2006; 51:1221-5. [PMID: 16944014 DOI: 10.1007/s10620-006-8037-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 11/29/2004] [Indexed: 12/26/2022]
Affiliation(s)
- Aline Charabaty Pishvaian
- Department of Medicine, Division of Gastroenterology, Georgetown University Hospital, 10502 Prairie Landing Terrace, 3800 Reservoir Road NW, Main Building, Washington, DC 20007, USA.
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23
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Irga N, Mierzejewska M, Balcerska A. [Spontaneous splenic rupture in the course of infectious mononucleosis]. Med Wieku Rozwoj 2006; 10:961-6. [PMID: 17401185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Spontaneous splenic rupture (SSR) in the course of infectious mononucleosis (IM) is a rare but potentially fatal complication. Mortality rate is relatively high, therefore emergency splenectomy is a life-saving intervention. In case of undergoing urgent operation there is no possibility to initiate proper prophylaxis of overwhelming infection. The humoral and cellular immunologic response impairment is a reason for life-threatening complications of splenectomised person. Asplenic children should receive infection prophylaxis immediately post splenectomy. We report two cases of splenic rupture inpatients with IM. The prevention of infection was initiated in both children. The mainstays of prophylaxis are: immunization, chemoprophylaxis and education. Complex information concerning asplenia-related subjects should be provided for patients and their parents.
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Affiliation(s)
- Ninela Irga
- Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Akademia Medyczna, ul. Debinki 7, 80-952 Gdańsk, Poland
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24
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Dillingh SJ, Jira P, Morroy G, Wolters B, Beutler J, Schneeberger PM. [Two patients with Hantavirus infection in The Netherlands; substantial increase in incidence in neighbouring countries]. Ned Tijdschr Geneeskd 2006; 150:1303-6. [PMID: 16821456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 12-year-old girl and a 57-year-old woman were admitted with fever, general malaise, abdominal pain, nausea and vomiting. Both patients had acute renal insufficiency based on tubulointerstitial nephritis caused by the genus Hantavirus, which was confirmed by blood tests. Both patients recovered spontaneously. The neighbouring countries of France, Germany and Belgium have recently reported 2- to 7-fold increases in the number of Hantavirus infections. Hantavirus is a zoonotic viral disease that is transmitted by mice and is found in humans worldwide. Infection with Hantavirus is associated with severe renal impairment and thrombocytopenia, which usually resolves spontaneously. Recognition of the clinical signs and targeted serological testing can lead to adequate management of the disease. Diagnosing patients with Hantavirus infections will also help to prevent infections in The Netherlands and track epidemiological changes.
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Affiliation(s)
- S J Dillingh
- Afd. Kindergeneeskunde, E7, Jeroen Bosch Ziekenhuis, Postbus 90153, 5200 ME 's-Hertogenbosch.
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25
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Wetter A, Schaudt A, Lehnert T, Schmidt-Matthiesen A, Jacobi V, Vogl TJ. Small-bowel intussusception as a rare differential diagnosis in HIV-positive patients with acute abdominal pain. Eur Radiol 2005; 16:952-3. [PMID: 15895234 DOI: 10.1007/s00330-005-2785-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 03/12/2005] [Accepted: 04/07/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Axel Wetter
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Frankfurt, Germany.
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Abstract
The objectives of this study were to describe the clinical presentations and outcomes of all HIV+ patients who presented to the Emergency Department (ED) with a chief complaint of abdominal pain and to compare the outcomes of those with advanced disease (CD4 < 200/mm(3)) to those with early or middle stage disease (CD4 >or= 200/mm(3)). We conducted a retrospective chart review in an urban municipal hospital ED and included subjects if they were HIV+ and had a chief complaint of abdominal pain. Demographic and clinical data were entered into a standardized database; patients with advanced disease were compared with those with early or middle stage disease. One hundred eight patient visits were reviewed. The mean age was 37 +/- 7.6 years with mean CD4 count of 263/mm(3); 44% had CD4 counts <200/mm(3). Abdominal pain of unknown etiology, gastroenteritis/diarrhea, and ulcer disease/gastritis/dyspepsia were the three most common diagnostic categories for all patients. With the exception of disseminated mycobacterial disease, there were no statistically significant differences between the two groups. AIDS-associated opportunistic infections represented only 10% of the ED diagnosis of those patients with advanced disease. Only 8% of patients required intra-abdominal surgical procedures, however, 37% were admitted compared with 18% of patients without HIV disease (p < 0.001). Patients infected with HIV presenting with abdominal pain most often have a non-HIV related cause of abdominal pain and infrequently require surgery. However, HIV+ patients are admitted at twice the rate of the non-HIV infected population.
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Affiliation(s)
- Douglas Yoshida
- Emergency Services, San Francisco General Hospital, San Francisco, California, USA
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Abstract
OBJECTIVES Hepatitis C virus is a common chronic infection that is widely associated with symptoms of fatigue and pain in the right upper quadrant. Nausea may be an underrecognized symptom. This study was designed to study the frequency of nausea in patients with hepatitis C virus infection compared to controls. METHODS A cross-sectional study design with consecutive outpatients was used. Three groups were administered a dyspepsia and a previously validated Nausea Profile questionnaire. Univariate and multivariate analysis was performed. RESULTS A total of 64 hepatitis C virus (HCV) patients, 53 liver disease controls (LC), and 64 normal controls (NC) were studied. An increased period prevalence of nausea was found in HCV patients 43% versus 29.7% in NC and 18.9% in LC (p = 0.009). There was an increased frequency of fatigue and abdominal pain in HCV patients over 1 month compared to LC and NC combined (p = 0.0001 and 0.0065 respectively). The Nausea Profile score revealed statistically higher total scores and higher subscale scores in the HCV group compared to controls. The total NP score expressed as a percentage of the maximum was 27% in HCV versus 12.7% for LC and 9.2% for NC (p = 0.0005). The odds of nausea using logistic regression were 2.1 CI (1.0-4.5) in HCV patients compared to controls (p = 0.05). Using linear regression, higher Nausea Profile scores were found to be independently associated with the diagnosis of HCV (.0005), fatigue (p = 0.0003), and abdominal pain (p = 0.0001). CONCLUSIONS HCV infection is associated with an increased risk for nausea. The strong association between abdominal pain and nausea may be a clue to the etiology of nausea in these patients. Further etiological studies are needed.
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Affiliation(s)
- T R Riley
- Department of Medicine and Health Evaluation Sciences, The Pennsylvania State University-The Hershey Medical Center, 17033, USA
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Itoh M, Kawaguchi S, Yago K, Shimada H, Muro H. Acute abdominal pain preceding cutaneous manifestations of varicella zoster infection after allogeneic bone marrow transplantation. TOHOKU J EXP MED 2001; 195:61-3. [PMID: 11780725 DOI: 10.1620/tjem.195.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.
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Affiliation(s)
- M Itoh
- Department of Internal Medicine, Shizuoka General Hospital, Japan.
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Abstract
Patients with disseminated herpes zoster may present with severe abdominal pain that results from visceral involvement of varicella-zoster-virus infection. In the absence of cutaneous eruptions of herpes zoster, visceral herpes zoster is extremely difficult to diagnose. This diagnostic difficulty has the potential to cause devastating delays in treatment. We report a case series of four patients with visceral herpes zoster in whom large concentrations of DNA from varicella zoster virus were detectable in blood by PCR before signs of infection appeared on the skin, thus enabling early diagnosis and treatment.
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Szabó F, Horvath N, Seimon S, Hughes T. Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual triad in a patient 6 months post mini-allogeneic peripheral stem cell transplant for chronic myeloid leukemia. Bone Marrow Transplant 2000; 26:231-3. [PMID: 10918438 DOI: 10.1038/sj.bmt.1702486] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe abdominal pain followed by inappropriate antidiuretic hormone secretion (SIADH) preceding by several days the skin manifestation of varicella-zoster virus (VZV) infection in an immunocompromised patient is described. This is a rare presentation of a severe infection described previously only once in a chronic myeloid leukemia (CML) patient 5 months post allo-BMT during immunosuppressive treatment with cyclosporin A. This is the first case described in the setting of non-myeloablative preparation with fludarabine and melphalan and followed by donor leukocyte infusion (DLI) 2 and 4 months post allo-BMT. The influence of these factors on development of VZV virus infection is discussed. We also highlight the high incidence and high mortality in VZV infection in immunocompromised patients as well as the frequent atypical presentation.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/virology
- Chickenpox/complications
- Chickenpox/etiology
- Chickenpox/virology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Herpes Zoster/complications
- Herpes Zoster/etiology
- Herpes Zoster/virology
- Herpesvirus 3, Human
- Humans
- Immunocompromised Host
- Inappropriate ADH Syndrome/etiology
- Inappropriate ADH Syndrome/virology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Leukocyte Transfusion
- Male
- Middle Aged
- Transplantation, Homologous/adverse effects
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Affiliation(s)
- F Szabó
- Royal Adelaide Hospital, Department of Haematology and Bone Marrow Transplantation, Australia
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